EFFECTS OF EN-BLOC ESOPHAGECTOMY ON NUTRITIONAL AND IMMUNE STATUS IN PATIENTS WITH ESOPHAGEAL-CARCINOMA

Background and Objectives: En bloc esophagectomy has been established as the treatment of choice for patients with resectable esophageal car cinoma. However, an extensive surgical procedure may result in further impairment of the patient's nutritional status and immune system. Thu s a prospective study was undertaken to evaluate the perioperative seq uential changes in patients' nutritional and immune status and the tim ing to institute postoperative adjuvant therapy.Methods: Thirty-seven patients (34 male, 3 female) who had undergone en bloc esophagectomy w ith gastric institution for epidermoid carcinoma of the esophagus were studied. The mean age was 62.3 years. The nutritional and immune asse ssments were performed preoperatively, on the third postoperative day, in the first week, second week, third week, and at the end of the fir st and third month. The biochemical studies for nutritional evaluation included serum albumin, cholesterol, iron, transferrin, magnesium, zi nc, total iron binding capacity (TIBC), and nitrogen balance. Evaluati on of the immune status consisted of: (1) total lymphocyte count, (2) lymphocyte subpopulation, (3) immunoglobulins, (4) complements (C3 and C4), (5) lymphocyte blastogenic responses, (6) tumor necrosis factor- alpha and interleukin-2 secretion activity from mononuclear cells, and (7) C-reactive protein (CRP) level. Results: All the parameters in nu tritional assessment declined profoundly by the third postoperative da y (P < 0.05). The most severe deterioration was in serum iron, followe d by transferrin, TIBC, cholesterol, and zinc. Most of them returned t o the preoperative levels within 2-3 weeks after surgery. However, the serum levels of iron, transferrin, and TIBC required a longer period of time (>1 month) to return to normal. A remarkable increase of serum CRP was detected in the first postoperative week (P < 0.05), but immu noglobulins and complements decreased significantly yet variably (P < 0.05) in the second or third postoperative week before gradually retur ning to preoperative levels. Moreover, during the first week after sur gery, CD3 and CD8 diminished following esophageal surgery, whereas CD2 0, CD4/CD8 ratio, and lymphocyte blastogenic responses increased signi ficantly (P < 0.05). Conclusions: Except for iron-related parameters, all the other nutritional parameters returned to the preoperative leve l by the third postoperative week. An adequate supplementation of iron and protein for 1-3 months after surgery is needed. En bloc esophagec tomy might have only a mild and temporarily adverse effect on the host immune defense. Regarding the postoperative recovery of a patient's n utritional and immune status, post operative chemo-radiotherapy is opt imally instituted after the third postoperative week, instead of withi n 2 weeks of surgery. (C) 1998 Wiley-Liss, Inc.